Make it less painful
The licensing process to obtain oral morphine for medical use must be simplified. Harmala Gupta writes.india Updated: Aug 15, 2012 21:58 IST
Morphine invariably conjures up the image of hopeless junkies shooting poison into their veins. An image that blinds us to the fact that it's a wonder drug when used under medical supervision. Not only is it the most effective drug for pain, but when used for this purpose it's not in the least addictive. Sunita, whose insides were ravaged by disease, has to say this about morphine, "Do not ever let anyone suffer pain, for this is how cancer wins."
Hamstrung by an ancient British law and unchanged popular perceptions, it is estimated that at least 7 million people in India are denied pain relief annually. We have to change this. Ironically, while the British - from whom India inherited The Narcotic Drugs and Psychotropic Substances (NDPS) Bill - have changed their policy on this matter, we remain where we were. Today, the use of oral morphine for pain relief is the cornerstone of good medical care in Britain and worldwide. In India, on the contrary, the NDPS Bill, despite recent amendments, continues to place the onus for simplifying licensing procedures on states. This has denied access to opioids like oral morphine to patients in the past and is unlikely to change.
When this is coupled with draconian legislations, with no recourse to hearing or bail for those who legitimately manufacture and trade in opioids, you have a tragic situation. Unless the Centre takes on the responsibility of ensuring simplified and uniform regulations across India, legitimate retailers won't stock drugs like oral morphine and doctors will fear prescribing them.
In the 1940s, the only way to douse pain was to give patients a mixture containing cocaine or 'The Brompton cocktail'. This was far from satisfactory and prompted Cicely Saunders, a British nurse and social worker, to undertake research on the needs of the dying in the 1950s. In 1967 she founded St Christopher's, which became a catalyst for the development of the modern hospice and palliative care movement. It was here that scientific studies undertaken by Robert Twycross, among others, began to establish the efficacy of oral morphine for sustained pain relief. Patients with intractable pain were administered doses of morphine by the mouth and by the clock. The result was effective pain control with no fear of addiction or unpleasant side effects. In 1990, the World Health Organisation came out with an analgesic ladder for pain control in which it recommended that opioids like oral morphine and codeine be combined with analgesics for intractable pain.
These advances have largely bypassed us. Many members of our medical fraternity continue to harbour misconceptions about oral morphine, as they don't have the experience of using it, and the principles of palliative care are not taught in medical schools in India. Our policymakers, too, seem to be hampered by their inability to look beyond the potential for abuse and misuse. This is a matter of concern, as India has signed several international treaties and conventions which oblige it to make opioids available for medical use. Currently, India has the dubious distinction of using only one-thousandth of the morphine consumed in the world for medicinal purposes.
Much of medical practice and training in India is based on a flawed model that does not consider a patient's needs. Keeping the patient pain-free should be the number one priority. Making oral morphine more widely available for medical use by simplifying current licensing procedures in every state in India is surely the way forward. It is to be hoped that the Centre will use the power vested in it to further amend the recently amended NDPS Bill to ensure this. Otherwise, it may be another decade before Sunita's wish becomes a reality and you and I can hope to die free of pain.
Harmala Gupta is founder and president, CanSupport
The views expressed by the author are personal